Contentions

Michael Kinsley’s thoughtful column on rationing of healthcare reveals a basic, unspoken truth: of course the Democrats’ healthcare reform will ration care. Kinsley seems to think that is not altogether a bad thing. He writes:

The administration is investing great hopes (and $1.1 billion of stimulus money) in “comparative effectiveness research.” Because we don’t collect and compare in any systematic way the vast piles of data we have about individual patients and their treatment, we know astonishingly little about which treatments work and which are a waste of money. The administration is touting the figure of 30 percent of all health-care costs as spending that may accomplish nothing.

Nevertheless, he acknowledges that even if this research comes up with the “right” answer about treatment options, there will still be people denied care since some of those treatments deemed less effective do help some people, or might help some people.

But it is really much more than that. We know how these boards function. What begins as an effort for quality control soon devolves into a search to limit costs, regardless of the impact on patients. Scott Gottlieb of AEI writes:

In countries such as France and Germany, layers of bureaucracy like health boards have been specifically engineered to delay the adoption of new medical products and services, thus lowering spending.

In France, assessment of medical products is done by the Committee for the Evaluation of Medicines. Reimbursement rates are set by the National Union of Sickness Insurance Funds, a group that also negotiates pay to doctors.

In Germany, the Federal Joint Committee regulates reimbursement and restrictions on prescribing, while the Institute for Quality and Efficiency in Healthcare does formal cost-effectiveness analysis. The Social Insurance Organization, technically a part of the Federal Joint Committee, is in charge of setting prices through a defined formula that monitors doctors’ prescribing behavior and sets their practice budgets. In the past 12 months, the 15 medical products and services that cleared this process spent an average 35 months under review. (The shortest review was 19 months, the longest 51.)

When “comparative effectiveness research” was slipped into the stimulus plan, James Capretta likewise pointed out what this is really all about:

The idea is to study medical practice patterns, new products, and new technology to determine what is “cost effective.” In the UK, a similar program run by the National Institute for Clinical Evidence (NICE) is used to deny payment by the government for certain drugs and procedures that are said to be “cost ineffective.”

Democratic lawmakers will deny that rationing is their intent, but that is not credible. Why create a government program to study what’s cost effective if not to use the information to inform payment and coverage decisions? The problem is that this kind of research inevitably includes value judgments (how much is an extra year of life worth?) and interpreting the data is more art than science. In the wrong hands (like a distant government bureaucracy), so-called effectiveness research can be very dangerous indeed.

It is ironic, of course, that liberals who have vilified HMOs for chiseling on care and denying treatment to patients for cost reasons now want the government doing that for the entire country.

The last people we want making decisions about the relative merits of care options are boards of faceless, non-accountable government bureaucrats. And if we are going to go down the road of imposing more government-devised restrictions on care, we should at least be honest that the the plan intends to use impersonal bureaucracy to take away care. That, after all, is central to making it all “affordable.” If we really wanted to eliminate unneeded procedures and tests, we’d insulate doctors from the trial lawyers and put people in charge of paying for their own insurance.